Experiencing Cosmetic Problems After Breast Reconstruction?

Q: I recently had breast surgery. I think my nipples are positioned too high up, and one breast is harder than the other. What can I do?

A:Usually asymmetries in this situation can at least be improved, although it is often best let a few months (at least) pass first for the tissues to heal. If one breast is hard, it could mean that you have a significant fat necrosis under the skin, although there could be other reasons. I would strongly urge you to see your surgeon and share your concerns with him or her.

Q: In December 2011 I had a bilateral mastectomy with immediate tissue expanders, followed by silicone implant and nipple tattoo. My problem is that I have developed the “double bubble” look, rippling and contractors bilaterally.

I am 63 and realize that my age does reflect my outcome, however, I just need to know if I am alone or if you have patients that experience this? All of the pics I have seen have really great results and none of them look like me!

I am facing another surgery now to remove these implants and replace them with a different shape. I forgot to mention the cleft/ledge above each implant. They tried fat grafting but it was minorly successful. I need advice and have searched the internet with no success. Can you help?

A:Your situation is far from unique, especially if you don’t have much thickness of soft tissue cover over the implants. Rippling, implant malposition (double-bubble), and contracture are unfortunately fairly common problems even after cosmetic breast augmentation, and can be yet more common after reconstruction.

Our practice is limited to fully autologous breast reconstruction using perforator flaps (DIEP, sGAP, PAP). The surgery to replace the implants with your own tissue is long (6-8 hrs), and carries risks not associated with implant reconstruction alone, so it is not for everyone. Having said that, we have successfully removed implants and replaced them with flaps hundreds of times, and it can work very well indeed (especially if you have a good flap donor area).

There are some additional options your surgeons might consider, if you don’t want to pursue complete implant removal and replacement with your own tissue. These include the addition of latissimus flaps to the implant reconstruction, or potentially the addition of acellular dermal matrix (Alloderm, etc.) to cover the implants. We don’t perform these procedures, but they are commonly available in almost all areas, and can bring extra “cover” over the implants.

Dr. Richard M. Kline, Jr

Center for Natural Breast Reconstruction

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